FISCAL YEAR 2016-17 3 RD QUARTER UPDATE AND DRAFT BUDGET FY 2017-18 - PowerPoint PPT Presentation

FISCAL YEAR 2016-17 3 RD QUARTER UPDATE AND DRAFT BUDGET FY 2017-18 mmUnityCare

GENDA Fiscal Year 2016-17 Update Information that informs the budgeting process Fiscal Year 2017-18 Budget Information

JUNE 2017 – 9 TH MONTH OF THE FISCAL YEAR Encounters were 5.5% under budget for the month and 2.9% greater than June 2016. Medical encounters were under budget by 1,761 (7%) for the month and 7,629 year to date (3.5%). Year to date, total encounters are 6,838 or 2.6% under budget, and 13,103 o 5.4% greater than prior year.

ENCOUNTERS Encounter Comparison 300,000 FY 16 - 244,815 250,000 Budget - 264,756 200,000 FY 17 – 257,918 150,000 100,000 50,000 - FY 2015-16 Budget FY 2016-17 Behavioral Health 12,042 10,738 12,849 Dental 35,123 36,839 35,519 Medical 197,650 217,179 209,550

JUNE 2017 – 9 TH MONTH OF THE FISCAL YEAR June revenue was $36,900 under budget, and year to date is $5.8 million under budget, encounters are under budget. June expenses were under budget by $281, 000 and year to date expenses ar almost $7 million under budget as well. June operations reflected an excess of $454,000 and year to date the excess $1.3 million.

Actual 2016-17 as of Budget June 30, 2017 2016-17 Encounters 257,918 264,759 T otal Patient Service Revenue 27,978,908 29,916,152 T otal Grant Revenue 7,584,408 6,374,998 Other Revenue CCC Primary Care Agreement 26,072,693 29,024,163 Other 225,000 DSRIP Revenue 9,963,451 11,917,308 DSRIP Revenue ATCIC 312,489 239,553 T otal Other Revenue 36,348,633 41,406,024 T otal Revenue 71,911,949 77,697,174 Expenditures Salaries and Wages 35,840,227 39,232,450 Contract Labor 4,846,086 5,322,986 Employee Benefits 9,274,758 10,394,126 Supplies 5,137,825 6,688,325 Professional Fees 295,179 207,798 Contracted Services 9,811,069 9,567,191 Insurance 140,826 124,339 Occupancy 3,431,738 3,204,602 Equipment 389,950 475,369 Bad Debt 1,441,949 2,389,108 Other Exp 466 - T otal Expenditures 70,610,073 77,606,294 Excess (Deficit) From Operations 1,301,876 90,880

JUNE 2017 – 9 TH MONTH OF THE FISCAL YEAR Gross cost per encounter is $273.77 compared to the annual budget of $294.29 and the prior year of $286.44. Gross cost is ALL costs, medical, behavioral, dental, IT, maintenance, billing – a overhead, everything. Gross cost per encounter is all costs divided by all encounters (medical, dental , behavioral, everything).

SOME ITEMS THAT CONTRIBUTE TO A HIGHER COST PER ENCOUNTER THAN OTHER COMMUNITY CLINICS David Powell (HIV/Aids) and ARCH (Homeless) Health Centers contributes $18 of the cost per encounter. Each of these clinics has much higher cost per encounter compared to the rest of our clinics given the special populations served. Pharmacy benefits – CommUnityCare has historically provided pharmacy benefits to sliding fee scale (SFS) patients for a modest co-payment. Pharmacy contributes $15 to cost per encounter with $13 of this $15 for the cost of buying medications.

JUNE 2017 – PROVIDER VACANCIES Provider Vacancy Trend Report FY17 to Date 14 True Vacancy: A position that is not currentl 13 an employed CUC provider. The vacancy ma not be covered by a locum or PRN provi 11 11 10 11 regular and/or interim basis. 10 8 8 9 Signed Offers: When a signed offer letter 7 received by a provider candidate, but they hav 7 started employment with CUC. Variances fro to month can include providers who sta 5 employment (reduction), newly signed offer (addition), carry over from the previous mo change), and/or a combination thereof. 4 4 4 4 4 3 1 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 True Vacancies Signed Offers

DSRIP UPDATE

DSRIP – CATEGORY 1 AND 2: VOLUME RELATED DSRIP Category I and II Projects DY6 Target June 2016 % o Data represents effort Disease Management Registry 7,192 7,027 through June 2017 Primary care Medical Home 53,153 48,960 • 75% of the DSRIP year Chronic Disease Management 7,192 7,027 complete. Expanded Primary Care 226,610 186,320 Dental Expansion: All Patient Types 43,000 33,015 GI/Hepatitis C – Initiative Dental Expansion: Pregnant Women 763 696 to maximize use of Dental Expansion: Patients with I Diagnosis 6,109 7,032 Advance Practice Dental Expansion: Patients with I Diagnosis + Pregnant 6,599 7,539 Professionals to support Telepsychiatry: Encounters 2,700 2,399 this work. Pulmonology 3,827 2,847 Gastroenterology Clinic 4,343 3,100 Mobile Health Teams: Encounters 4,000 3,201 Centering Pregnancy 164 143 Integrated Behavioral Health: Enrollment into Disease Registry 400 1,277 Integrated Behavioral Health: Providing Care according to Established IBH Care Protocols 400 1,479

DSRIP – CATEGORY 3 UALITY DSRIP Category III DY6 Target June 2017 Difference % o epresents effort through June 2017 Comprehensive Diabetes LDL Screenings (18-64 yoa) 83.56% 76.50% 7.06% 75% of the DSRIP year complete Diabetes Care: Foot Exam (18-64 yoa) 77.38% 87.20% -9.82% Diabetes Care: Nephropathy (18-64 yoa) 87.85% 89.86% -2.01% od Pressure (BP) control and LDL Tobacco Use Screenings and Cessation (18 yoa plus) 80.94% 99.57% -18.63% emain below target. We have High Blood Pressure Screening (18 yoa plus) 50.09% 58.21% -8.12% igned and implemented multiple Adult BMI Assessment and Follow-Up (18-64 yoa) 71.33% 98.45% -27.12% ative to address these and Controlling High Blood Pressure for Diabetics (18-64 yoa) 71.28% 70.90% 0.38% mprovement is beginning. We expect Controlling High Blood Pressure for Dental Patients (18-64 yoa) 64.41% 67.34% -2.93% meet target for BP control by year Hepatitis C Cure Rate (18-64 yoa) 30.23% 95.18% -64.95% . Asthma Percent Opportunity Achieved (all ages) 26.67% 35.29% -8.62% Improvement of PHQ-9 (all ages) 13.28 10.42 Annual Monitoring for Patients on Diuretics (18 yoa plus) 86.09% 90.53% -4.44% Annual Monitoring for Patients on ACE / ARBs (18 yoa plus) 85.72% 90.88% -5.16% Diabetes Care: Retinal Eye Exam (18-64 yoa) 48.73% 61.26% -12.53%

DRAFT BUDGET FY 2017-18

BUDGETARY PRESSURES – COMMUNITY HEALTH CENTER FISCAL CLIFF

CHC FISCAL CLIFF – IMPACT ON CUC IF CONGRESS DOESN’T ACT

THER INFORMATION INFORMING THE BUDGETING PROCESS ¡ The number of clinics will not change during the year. RBJ Dental will clos at the end of August 2017 due to construction noting that staff and the services are being relocated to one of our other 4 dental locations. We al anticipate establishing primary care medical services within the Del Valle community. ¡ Encounters –developed with the Chief Medical Officer, targets for each type of provider.

REVENUE Patient Service Revenue is estimated by type of payor; Medicare, Medicaid, CHIP , Commercial Insurance, State Family Planning, Pharmacy Network. ¡ MAP and Sliding Fee Scale (SFS) in this category consists of the patient co-payment portion, amounts due from the CCC are in Other Revenue. Grant Revenue-estimated based on current approved grants. Most grant periods ar not aligned with the fiscal year, information is estimated based on known amounts.

REVENUE Other Revenue ¡ CCC investment – Still under construction. This will be a multiple payment simil to the prior year. ¡ Potentially multiple payment parts- ¡ Medical, Dental, Specialty, and Behavioral Health payment per encounter for MAP and Sliding Fee Scale with carve outs for DSRIP projects and David Powel ¡ Community Benefit to support Pharmacy, David Powell and family planning services. ¡ Payment for “non encounter” services such as care management, nurse visits, clinical pharmacists and nutritionist. ¡ Payment for achievement of access and quality measures.

REVENUE ¡ DSRIP – Delivery System Reform Incentive Payment – Budgets have not been prepared, this is an estimate.

EXPENSES Salaries, Contract Labor, Employee Benefits ¡ Salaries are increased by 3% for merit and additional $500,000 for market adjustments. Staff is added for selected areas, mostly care management, this is sti in review. ¡ Contract Labor – primarily provider cost to operate Hancock, Blackstock, Gastroenterology, Pulmonary, OB/Gyn, and internal medicine at Southeast. ¡ Employee Benefits – determined by the number of employees and the contracted benefit cost. Supplies – the category was increased 3% and $200,000 added for computer refres

EXPENSES Professional fees – This category is largely physician recruitment fees, includes some accounting and legal fees. Contracted Services – There are many items in this category, the largest is Information Technology . Other items are behavioral health, billing & collection services, lab services, translation services, payroll services and maintenance. The category was increased 3%, lab was increased an additional $500,000, Information Technology received an additional base increase of $228,000 plus $140,000 for the communication system. Insurance – This is mostly property and general liability, insurance is jointly with Central Health. CommUnityCare receives professional liability coverage through the Federal Tort Claims Act (FTCA) because of FQHC status.

EXPENSES Occupancy – This is rent, utilities, janitorial, security. The category was increased 3% plus an increase of $234,000 for rent at the Atrium previously assumed by the Community Care Collaborative (CCC). Equipment – This is mainly depreciation and copier or other equipment rental. It w increased 3%. Bad Debt – This was assumed to be similar to FY17.